Cover Page. The handle holds various files of this Leiden University dissertation.
|
|
- Stewart Blankenship
- 5 years ago
- Views:
Transcription
1 Cover Page The handle holds various files of this Leiden University dissertation. Author: Yusuf, Erlangga Title: On how obesity links with osteoarthritis Issue Date:
2 Association between several clinical and radiological determinants with long-term clinical progression and good prognosis of lower limb osteoarthritis Erlangga Yusuf 1, Jessica Bijsterbosch 1, P Eline Slagboom 2, Herman M Kroon 3, Frits R Rosendaal 4, Tom WJ Huizinga 1, Margreet Kloppenburg 1,4 From: Leiden University Medical Center, Leiden, The Netherlands 1 Department of Rheumatology 2 Department of Molecular Epidemiology 3 Department of Radiology 4 Department of Clinical Epidemiology Published in: PLoS One. 2011;6(10):e25426.
3 ABSTRACT Objective To investigate the factors associated with clinical progression and good prognosis in patients with lower limb osteoarthritis (OA). Methods Cohort study of 145 patients with OA in either knee, hip or both. Progression was defined as (i) new joint prosthesis or (ii) increase in WOMAC pain or function score during 6-years follow-up above pre-defined thresholds. Patients without progression with decrease in WOMAC pain or function score lower than pre-defined thresholds were categorized as good prognosis. Relative risks (RRs) for progression and good prognosis with 95% confidence interval (95% CI) were calculated by comparing the highest tertile or category to the lowest tertile, for baseline determinants (age, sex, BMI, WOMAC pain and function scores, pain on physical examination, total range of motion (trom), osteophytes and joint space narrowing (JSN) scores), and for worsening in WOMAC pain and function score in 1-year. Adjustments were performed for age, sex, and BMI. Results Follow-up was completed by 117 patients (81%, median age 60 years, 84% female); 62 (53%) and 31 patients (26%) showed progression and good prognosis, respectively. These following determinants were associated with progression: pain on physical examination (RR 1.2 (1.0 to 1.5)); trom (1.4 (1.1 to 1.6); worsening in WOMAC pain (1.9 (1.2 to 2.3)); worsening in WOMAC function (2.4 (1.7 to 2.6)); osteophytes 1.5 (1.0 to 1.8); and JSN scores (2.3 (1.5 to 2.7)). Worsening in WOMAC pain (0.1 (0.1 to 0.8)) and function score (0.1 (0.1 to 0.7)), were negatively associated with good prognosis. Conclusions Worsening of self-reported pain and function in one year, limited trom and higher osteophytes and JSN scores were associated with clinical progression. Worsening in WOMAC pain and function score in 1- year were associated with lower risk to have good prognosis. These findings help to inform patients with regard to their OA prognosis. 56
4 Determinants of bad and good prognosis of lower limb OA 3.1. INTRODUCTION Osteoarthritis (OA) of the lower limbs accounts for problems in performing lower extremities tasks such as walking and stair climbing. 1 Some of the patients with lower limb OA show progression of their OA with some progressing to total joint failure needing joint replacement. 2 Knowing those who will progress is important because it will improve patient information on the prognosis of OA. Several studies have investigated determinants of the progression of knee and hip OA 3-5 and several remarks could be made on these studies. Firstly, none of the studies investigated knee and hip together. Investigating knee and hip separately is easy to understand but it does not reflect the clinical practice. In more than 30% of knee OA patients, hip OA is present at the same time 6 and up to 78% of patients have bilateral OA in knees or hips. 7 Concomitant presence of OA in lower limb joints will affect the experience of pain and influence disability in all lower limb joints. Arguably, it is difficult for a patient to allocate complaints to a particular knee or hip joint. The questionnaires used in OA, such as Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (appendix B.1) asked questions on daily life activities such as climbing the stairs, where knee and hip joints are simultaneously needed. 8 Secondly, in most studies, progression was defined as joint deterioration on a radiograph while from the patient s perspective clinical progression is more important. 2,9 Thirdly, almost exclusively baseline determinants of progression were investigated. However, OA patients are included in cohort studies at varying stages of the OA disease course, which make changes in determinants over a short time period of interest as prognostic factors on the long term. 3 Clinical progression is relevant for patients, but it is difficult to define. Probably this is one of the reasons why data on clinical progression are lacking compared to data on radiological progression. At this moment, there is no consensus on how to define clinical progression of knee and hip OA progression. 10,11 Obviously, total joint replacement should be considered as OA disease progression. However, not all patients with worsening of their OA will receive joint replacement because of 57
5 factors such as patient s comorbidity and surgeon s preference. Self-reported pain or disability could be used to define clinical progression, yet at present no standardized cut-off for progression on self-reported outcome measures exists. To deal with the abovementioned issues, we propose in the present study a composite outcome which combines total joint replacement and increase in self-reported pain and function during 6-years follow-up above a clinically relevant cut-off 8 as clinical progression. We sought to identify determinants associated with clinical progression and determinants associated with good prognosis of lower limb OA (knee and hip OA together). We assessed baseline determinants and determinants which were measured repeatedly over time PATIENTS AND METHODS Study design and patient population This study is part of the Genetic ARthrosis and Progression (GARP) study, a cohort study aimed at identifying determinants of OA susceptibility and progression. 12 In this cohort, 192 Caucasian sib-pairs (384 patients), aged 40 to 70 years were included. To be included, patient should have symptomatic OA at multiple joint sites in the hands or OA in two or more of the following joint sites: hand, spine (cervical or lumbar), knee, or hip. Patients were recruited from the rheumatologic, orthopedic and general practice clinics around Leiden, The Netherlands. Patients with secondary OA, familial syndromes with a clear Mendelian inheritance, and a shortened life expectancy (<1 yr) were excluded. Patients underwent baseline assessment between August 2000 and March 2003 and filled-in questionnaires one year after this baseline visit. From April 2007 to June 2008 patients who consented for a follow-up evaluation (mean follow-up 6.1 years (range 5.1 to 7.5 years) were assessed. To be eligible for the present study, patients needed to have OA in either knee or hip, or both. Knee OA was defined according to American College of Rheumatology (ACR) criteria as pain or stiffness in the knee on most days of the prior month and the presence of osteophytes in the tibiofemoral joints. 13 Hip OA was also defined 58
6 Determinants of bad and good prognosis of lower limb OA according to ACR criteria as pain or stiffness in the groin and hip region on most days of prior month together with femoral or acetabular osteophytes or joint space narrowing on the radiograph. 14 There were 168 patients with knee or hip OA in the GARP cohort. Of these patients, 23 patients with prosthesis at baseline were excluded leaving 145 patients eligible for the follow-up. Patients with prosthesis at baseline were excluded because these patients could be considered as already having progressive disease at baseline and because having first prosthesis could influence the decision in having another prosthesis (confounder). This study was approved by the Medical Ethics Committee of the Leiden University Medical Center. Written informed consents form were obtained from all participants Clinical assessment Demographic data at baseline were recorded using standardized questionnaires. Self-reported pain (five items) and functional limitations (17 items) were evaluated by using the Dutch version of the WOMAC (appendix B.1) in 100 mm visual analogue scale format at baseline, at 1-year and at 6-year follow-up. It considered both knees and hips in the last 48 hours. Total scores on the pain and function subscales range from 0 to 100, higher scores indicated worse outcome. Physical health at baseline was assessed with the summary component scales for physical health (PCS) of the Dutch validated Medical Outcomes Study Short Form- 36 (SF-36, appendix B.4) derived from norm based data from the Dutch population (mean 50, standard deviation (SD) 10). 15,16 Higher scores indicate better physical health. Physical examinations were performed at baseline. Pain on passive movement of the knee and hip joint was assessed using the modified articular index described by Doyle et al. 17 (range 0 to 3; 0: no pain, 1: patient expressed tenderness, 2: patient expressed tenderness and winced, 3: patient expressed tenderness, winced and withdrew the joint). The total pain score ranged from 0 to 12. Flexion and extension of the knee and flexion and endorotation of the hip were measured using a goniometer and summed up as total range of motion (trom). 59
7 Radiographs Radiographs of the knees (posterior-anterior (PA); weight-bearing, non-fluoroscopic fixed-flexion protocol) and hips (PA; weight-bearing) at baseline were taken by a single experienced radiographer using a standard protocol with a fixed film focus distance (1.30 m). These analogue films were digitized using a film digitizer at a resolution corresponding to a pixel size of 100 mu. Using the OARSI atlas (appendix C.2) 18, two readers (EY, JB) scored the radiographs by consensus opinion. Osteophytes were graded 0 to 3 in the hip, on the medial and lateral femur and in the medial and lateral tibia. Joint space narrowing (JSN) was graded 0 to 3 in the hip, and in medial and lateral tibiofemoral compartments of the knees. Total scores for osteophytes ranged from 0 to 24 in the knees and 0 to 6 in the hips. Total scores for JSN ranged from 0 to 12 in the knees and 0 to 6 in the hips. Intra-reader reproducibility based on 25 randomly selected pairs of radiographs was excellent, with intra-class correlation coefficient (ICC) of 0.99 for osteophytes and 0.98 for JSN Definition of progression and good prognosis Clinical progression was defined as: (i) the acquirement of joint replacement during follow-up or (ii) an increase in self-reported (WOMAC) pain or function from baseline to 6-years follow-up above the predefined MPCI (minimum perceptible clinical improvement). The joint replacement should be due to OA and not due to other forms of arthritis or trauma. MPCI was originally developed as threshold value to define treatment response in OA. The threshold values were 9.7 for WOMAC pain and 9.3 for WOMAC function. 8 These threshold values with negative sign, were used to define good prognosis. Patients without progression who had decrease in WOMAC pain or function score in 6-years lower than -9.7 or -9.3, respectively, were defined as having good prognosis Statistical analysis Data were analyzed using PASW Statistics 17 (SPSS Inc., Chicago, Ill, USA). Mean changes (SD and 95% confidence interval (95% CI)) for WOMAC pain and function, PCS and pain on examination scores were calculated by subtracting baseline scores 60
8 Determinants of bad and good prognosis of lower limb OA from follow-up scores. Mean changes of scores with the 95% CI that did not cross 0 was considered as significant. The self-reported pain and function change scores of every patient were plotted in cumulative probability plot. Determinants of clinical progression were assessed using logistic regression analysis. We assessed the following baseline determinants: age, sex, BMI, WOMAC pain and function scores, pain on physical examination, total range of motion (trom) and radiographic scores. We also assessed the determinants worsening in WOMAC pain and function score in 1-year. 3 The following baseline determinants were categorized in tertiles: BMI, WOMAC pain and function, trom, osteophytes, and JSN. Also categorized in tertiles were worsening in WOMAC pain and function in 1-year. Pain on physical examination was categorized into presence or absence of pain. In the logistic regression analysis, the odds ratios (ORs) were calculated by using the lowest category or the lowest tertile as reference except for trom where the highest tertile was used as reference. The ORs were transformed to risk ratio (RRs) using the approximation formula of Zhang because ORs of common outcomes in a fixed cohort are not a good approximation of RRs. 19 Since the population of this study consists of sib pairs, intrafamily effect were taken into account by computing robust standard errors using Stata version 8 (Stata, College Station, Tx, USA). In the analyses, adjustments were made for age, sex, and BMI. A significant determinant of progression was defined as a determinant that the 95% CI of its RR did not cross 1. The significant determinants were included in a multivariate model to investigate whether these determinants could independently predict the clinical progression. To get an impression on how good these determinants predict clinical progression when they presented together, the R 2 of this model was determined. Additionally, to investigate the discriminative ability of the multivariate model, we fitted a receiver operating characteristics curve (ROC) and calculated the area under the curve (AUC). We compared the predicted risk of progression with the observed clinical progression and good prognosis with the observed clinical progression and good prognosis. 61
9 3.3. RESULTS Population description Of 145 patients eligible for the follow-up, 117 (81%) gave consent for follow-up assessment. The reasons for non-consent were: no interest in the follow-up study (n=8), unavailability of transport (n=8) health problems not associated with OA (n=4), emigration (n=1), and unknown (n=2). Five patients died during follow-up. Baseline characteristics of patients with and without follow-up and excluded patients due to joint prosthesis at baseline are presented in table 3.1. No difference was found between baseline characteristics of patients with and without follow-up (table 3.1). Table 3.1 Baseline characteristics of 168 patients with knee and/or hip OA stratified by availability of follow-up. Follow-up (n=117) No follow-up (n=28) Joint prosthesis at baseline (n=23) Age, yrs, median (IQR) 60 (55 to 66) 62 (53 to 58) 64 (61 to 68) Female, no (%) 98 (84) 24 (74) 13 (72) BMI, kg/m 2, mean (range) 28.0 (20 to 47) 27.3 (20 to 38) 29.3 (22 to 43) Patients with OA, no (%) Knee 74 (63) 18 (55) 3 (17) Hip 31 (27) 6 (18) 6 (33) Knee and hip 11 (10) 9 (27) 9 (50) Total range of motion,, mean (range) 258 (133 to 389) 257 (219 to 441) 251 (48 to 360) Knee flexion 86 (1 to 155) 86 (0 to 155) 85 (16 to 135) Knee extension -4 (-30 to 10) -3 (-30 to 16) -2 (-15 to 16) Hip flexion 134 (100 to 176) 134 (8 to 166) 133 (8 to 175) Hip extension 41 (0 to 80) 39 (0 to 80) 26 (8 to 49) Joint prosthesis, no. n/a n/a 23 Hip prosthesis 16 Knee prosthesis 6 Knee and hip prosthesis 1 Presence of pain on physical examination, no (%)* 85 (73) 20 (71) 17 (74) Hip 30 (26) 9 (32) 14 (61) Knee 64 (55) 16 (57) 11 (48) * Patients may have OA at multiple joints at one time and can have pain in the knee and hip joint simultaneously. Abbreviation: IQR, interquartile range; BMI, body mass index. 62
10 Determinants of bad and good prognosis of lower limb OA Clinical course of lower limb osteoarthritis The mean changes (95% CI) of self-reported (WOMAC) pain and function scores of all patients were -2.6 (-8.9 to 3.7) and 0.5 (-5.9 to 6.9), respectively (table 3.2). During follow-up, 36 patients (31%) received at least one joint replacement; 15 for the hip, 16 for the knee, and five for both knee and hip. In these patients with new joint replacements, the mean WOMAC pain score (95% CI) decreased over the six years of follow-up (-8.5 (-17.8 to -0.1)). In the patients without new prosthesis (n=81), WOMAC pain and WOMAC function scores did not change significantly over time: -0.1 (-8.3 to 8.1) and 1.9 (-6.3 to 10.1), respectively. 3 Cumulative probability plots show the variation in natural course of self-reported pain and function in the sub-group of patients without prosthesis (n=81) (figure 3.1). Fifteen and 22 patients showed progression of WOMAC pain and WOMAC function based on changes above the MPCI, respectively. In total, 26 patients (19.7%) showed clinical deterioration. Together with the 36 patients receiving joint replacement during follow-up, 62 of 117 patients (53.0%) showed clinical progression. Thirtyone patients showed good prognosis, based on change in WOMAC pain or WOMAC function score change lower than -9.7 (n=23) or -9.3 (n=22), respectively. In the total study sample, in the subgroup of patients with new prosthesis, and in patients without new prosthesis, physical health summary measures using SF-36 did not change during follow-up (table 3.2). Compared to the general population (mean of 50 with SD of 10), physical health of lower limb OA patients was consistently shown to be worse at baseline and follow-up. Pain during physical examination was worsened in the total population (table 3.2). In the sub-group with new prosthesis, pain did not worsen. 63
11 Figure 3.1 Cumulative probability plot of Western Ontario and McMaster Universities (WOMAC) scores change of patients without prosthesis during follow-up (n=81) for WOMAC pain scores change (above) and WOMAC function scores change (below). The horizontal line above is the line set at minimal perceptible clinical improvement (MPCI) score which is used as the cut-off to define progression and the horizontal line below is the line set to define good prognosis. 64
12 Determinants of bad and good prognosis of lower limb OA Table 3.2 Mean (standard deviation (SD)) baseline, follow-up (FU), and change scores on selfreported pain and function (WOMAC), physical health (PCS), and pain on physical examination (PE) for the total population and sub-groups. Baseline Follow-up Change (95% CI) All patients (n=117) WOMAC pain 36.2 (23.5) 33.6 (25.7) -2.6 (-8.9 to 3.7) WOMAC function 33.1 (24.3) 33.6 (24.8) 0.5 (-5.9 to 6.9) PCS 41.8 (9.8) 42.0 (10.1) 0.2 (-2.4 to 2.8) Pain on PE 1.7 (1.7) 2.4 (2.4) 0.7 (0.2 to 1.2) Patients receiving WOMAC pain 36.5 (18.2) 28.0 (21.0) -8.5 (-17.8 to - 0.1) prosthesis during FU WOMAC function 32.4 (20.1) 30.0 (20.6) -2.4 (-12.0 to 7.2) (n=36) PCS 40.8 (9.1) 40.7 (10.0) -0.1 (-4.6 to 4.4) Pain on PE 1.8 (1.6) 2.8 (3.1) 1.0 (-0.2 to 2.2) Patient not receiving prosthesis during FU (n=81) WOMAC pain 36.1 (25.6) 36.0 (27.2) -0.1 (-8.3 to 8.1) WOMAC function 33.4 (26.1) 35.3 (26.4) 1.9 (-6.3 to 10.1) PCS 42.3 (10.1) 42.6 (10.0) 0.3 (-2.8 to 3.4) Pain on PE 1.7 (1.8) 2.3 (2.1) 0.6 (-0.01 to 1.2) 3 : statistically significant; the significance of physical health summary were tested by comparing the study sample with the norm based population (mean=50, SD=10) Determinants of clinical progression of lower limb osteoarthritis Determinants of clinical progression of lower limb OA are shown in table 3.3. Age, female sex, and BMI, were not associated with clinical progression. Worsening of WOMAC pain and function scores in the first year were associated with 6-year progression while WOMAC pain and function score at baseline were not. Subjects in the highest tertile of WOMAC pain and function worsening in 1 year had a RR (95% CI) of 1.9 (1.2 to 2.3) and 2.4 (1.7 to 2.7), respectively, for clinical progression. The presence of pain on physical examination at baseline was associated with clinical progression (1.2 (1.0 to 1.5)). Patients in the lowest tertile of trom had a higher risk for clinical progression RRs of 1.4 (1.1 to 1.6). Osteophytes and JSN at baseline were associated with clinical progression, RR for being in the highest tertile of osteophytes and JSN scores were 1.5 (1.0 to 1.8) and 2.3 (1.5 to 2.6), respectively. In a multivariate regression model, WOMAC function worsening in 1 year, limited t ROM, and JSN scores were found as independent determinants of clinical progression (table 3.3). With these variables, explained variance (R 2 ) was 48.6%. The AUCs of the ROC curves were 0.85 (95% CI 0.76 to 0.94). 65
13 Table 3.3 Determinants for clinical progression over 6 years of lower limb osteoarthritis Determinant Number of patients Risk ratio (95% CI) 1 Risk ratio (95% CI) 2 + (%) - (%) Age > 60 years 59 (50) 50 (43) 1.0 (0.9 to 1.1) na Female sex 48 (41) 50 (43) 0.6 (0.3 to 1.0) na Body mass index (kg/m 2 ) < (16) 20 (17) 1 na 25.5 to (14) 21 (18) 0.9 (0.5 to 1.2) > (23) 14 (12) 1.3 (0.9 to 1.7) WOMAC pain scores 0 to (18) 18 (15) 1 na 23.2 to (17) 18 (15) 0.9 (0.5 to 1.3) > (18) 19 (16) 1.1 (0.7 to 1.4) WOMAC function scores 0 to (17) 20 (17) 1 na 18.0 to (19) 16 (14) 1.2 (0.7 to 1.6) > (17) 19 (16) 1.1 (0.7 to 1.5) Change in WOMAC pain score in 1 year < (9) 16 (14) 1 na to (13) 11 (9) 1.6 (0.8 to 2.2) > (15) 9 (8) 1.9 (1.2 to 2.3) Change in WOMAC function score in 1 year < (8) 17 (15) to (11) 14 (12) 1.5 (0.9 to 2.7) 1.9 (0.9 to 2.6) > (17) 5 (4) 2.4 (1.7 to 2.7) 2.3 (1.2 to 2.8) Pain on physical examination 44 (38) 13 (11) 1.2 (1.0 to 1.5) 1.2 (0.8 to 1.2) Total range of motion ( ) > (12) 25 (21) to (21) 14 (12) 1.4 (1.01 to 1.7) 1.2 (0.9 to 1.2) < (20) 16 (14) 1.4 (1.1 to 1.6) 1.2 (1.03 to 1.3) Osteophyte scores 1 19 (16) 28 (24) 1 na 2 to 4 19 (16) 10 (9) 1.4 (1.0 to 3.8) > 4 11 (9) 8 (7) 1.5 (1.0 to 1.8) JSN scores 1 19 (16) 32 (27) to 4 16 (14) 12 (10) 1.5 (0.9 to 2.1) 1.6 (0.7 to 2.4) > 4 14 (12) 2 (2) 2.3 (1.5 to 2.6) 2.4 (1.9 to 2.7) 1 except for determinants age, sex and BMI themselves, adjustment was made for age, sex and BMI 2 multivariate model using a backward selection (R 2 =48.6%). The independent variables with univariate associations with a p-value 0.10 were included Both models are calculated using approximation formula of Zhang. 19 +: with progression; -: without progression : statistically significant WOMAC, Western Ontario and McMaster Universities; JSN, joint space narrowing; na, not applicable 66
14 Determinants of bad and good prognosis of lower limb OA Table 3.4 Determinants of good prognosis of lower limb osteoarthritis over 6 years. Determinant Number of patients Risk ratio (95% CI) 1 Risk ratio (95% CI) 2 + (%) - (%) Age > 60 years 28 (24) 3 (3) 1.0 (0.7 to 1.0) na Female sex 29 (25) 68 (58) 2.8 (0.8 to 6.3) na Body mass index (kg/m 2 ) < (12) 25 (21) 1 na 25.5 to (10) 25 (21) 0.9 (0.4 to 1.6) > (4) 35 (30) 0.3 (0.1 to 0.9) WOMAC pain scores 0 to (4) 34 (29) 1 na 18.0 to (12) 24 (20) 2.7 (0.7 to 3.6) > (11) 27 (23) 2.2 (0.7 to 3.8) WOMAC function scores 0 to (5) 34 (29) 1 na 18.0 to (11) 24 (20) 2.5 (0.1 to 4.5) > (10) 27 (23) 1.9 (0.7 to 3.8) Change in WOMAC pain score in 1 year < (12) 12 (10) 1 na to (4) 21 (18) 0.3 (0.1 to 0.6) 0.6 (0.1 to 1.3) > (3) 23 (20) 0.1 (0.1 to 0.8) 0.5 (0.1 to 1.1) Change in WOMAC function score in 1 year < (13) 11 (9) to (4) 22 (19) 0.3 (0.1 to 0.7) 0.3 (0.1 to 0.8) > (2) 23 (18) 0.1 (0.1 to 0.7) 0.2 (0.1 to 0.8) Pain on physical examination 20 (17) 11 (9) 0.9 (0.6 to 1.1) na Total range of motion ( ) > (10) 27 (23) 1 na 522 to (8) 30 (26) 0.8 (0.3 to 1.7) < (9) 28 (24) 0.9 (0.4 to 1.8) Osteophyte scores 1 17 (15) 30 (26) 1 na 2 to 4 6 (5) 23 (20) 0.6 (0.2 to 1.2) > 4 4 (3) 15 (13) 0.5 (0.2 to 1.3) JSN scores 1 18 (15) 33 (28) 1 na 2 to 4 7 (6) 21 (18) 0.7 (0.3 to 1.4) > 4 2 (2) 14 (12) 0.4 (0.1 to 1.4) 3 1 except for determinants age, sex and BMI themselves, adjustment was made for age, sex and BMI 2 multivariate model using a backward selection (R 2 =48.6%). The independent variables with univariate associations with a p-value 0.10 were included Both models are calculated using approximation formula of Zhang. 19 +: with good prognosis; -: without good prognosis : statistically significant WOMAC, Western Ontario and McMaster Universities; JSN, joint space narrowing; na, not applicable 67
15 Determinants of good prognosis of lower limb osteoarthritis Worsening in WOMAC pain and function score in 1 year were negatively associated with good prognosis, i.e. patients in highest tertile of 1-year increase in WOMAC pain and function scores had lower risk to have good prognosis (table 3.4). Patients in the highest tertile of worsening of WOMAC pain and function in 1 year, had RR of 0.1 (95% CI 0.1 to 0.8) and 0.1 (0.1 to 0.7), respectively to have good prognosis of their lower limb OA compared to patients with WOMAC pain and function change in the lowest tertile. When these significant determinants were analyzed in one model, only worsening in WOMAC function in 1- year was negatively associated with good prognosis. The R 2 of this model was 43.3% and the AUCs of the ROC curves were 0.78 (0.68 to 0.89) DISCUSSION To our knowledge, the present study is the first which investigated determinants of clinical progression of knee and hip together. Clinical outcome is chosen because it is essential to patients. Clinical progression was present in 53% of patients; 33% by receiving joint prosthesis and 20% by deteriorating of self-reported pain or function. Self-reported pain improved over 6 years in patients who received prostheses. Selfreported function did not change over 6 years regardless of joint replacement. The combination of WOMAC function changes in 1 year, limited trom, and JSN scores provided the best explanation of variation in clinical progression of lower limb OA. Worsening WOMAC pain and function in 1 year were negatively associated with good prognosis. Patients in the highest tertile of worsening in WOMAC pain and WOMAC function in 1-year had 90% less chance to have good prognosis of their lower limb OA compared to patients with pain and function change in the lowest tertile. The proportion of the study sample showing clinical progression in our study is comparable to results from the Bristol OA 500 study. In that descriptive study, where the majority of the study population was also female, clinical change was reported by the patients as: better, same, and worse. They found that 63% and 54% of the patients reported worsening in overall condition for the knee and hip 68
16 Determinants of bad and good prognosis of lower limb OA respectively, after 8 years follow-up. 9 In the present study, self-reported pain and function for the whole group did not change in 6 years. This can be explained by the variation in progression between individuals as depicted in the cumulative probability plots (figure 3.1). Although some patients remained stable and even reported improvement, a considerable proportion of patients reported more pain and worse function. As a result the mean change is small. As expected in the subgroup of patients receiving joint prosthesis during follow-up, self-reported pain improved over 6 years, however, self-reported function did not. These results are consistent with the notion that joint replacement is an effective treatment for pain in lower limb OA. However, it seems that joint replacement cannot replace the function of the natural joint. Our results showed some parallels with a recent study by Nilsdotter et al. 20 They showed that patients had high preoperative expectations concerning reduction of pain and function but one year after knee replacement only the expectation regarding reduction of pain was fulfilled. 3 While self-reported pain at baseline was not associated with clinical progression, rapid deterioration in self-reported pain and function in the first year (even after correction for WOMAC scores at baseline that could confound the association) was associated with higher risk of progression over 6 years. This has not been studied before in OA, but it is in accordance with studies in rheumatoid arthritis (RA): worsening in self-reported disability measured with the health assessment questionnaire was a predictor for severe RA outcomes on the long term. 21 Interestingly, worsening in WOMAC pain and function score in 1-year were negatively associated with good prognosis. The consequence of these findings is that by following lower limb OA patients for 1 year, doctors can inform the patients about the progression of the OA in the long term. Therefore, it might advisable that doctors see their patients again 1-year after the first visit. It will be also interesting to investigate in a clinical trial whether modification of self reported pain or function one year after the presentation by means of physical therapy or better pain medication could stop the clinical progression of OA. 69
17 Pain on physical examination at baseline was associated with clinical progression. It was also the only pain variable that deteriorated over time. This observation reflects that pain as reported by the patient differs from pain on passive movement as found during physical examination as shown previously. 22 Limited trom (RR 1.4, 95% CI 1.1 to 1.6) and presence of pain on physical examination at baseline (RR 1.2, 95% CI 1.0 to 1.5) probably reflected the structural damage and might be used as a surrogate for osteophyte and JSN scores. In a recent EULAR recommendation for the diagnosis of knee OA, limited movement was indeed proposed as one of the clinical signs needed to make the diagnosis, probably because it was associated with radiological OA. 23 Osteophytes and JSN scores were also identified as determinants of lower limb OA progression. Our findings support the findings of Lane and colleague, that osteophyte, JSN together with subchondral bone sclerosis were associated with hip OA progression. 4 We showed that the WOMAC function changes in 1 year, limited trom and higher JSN scores were independently significant determinants of clinical progression of lower limb OA. Although the main aim of this paper was to identify the determinants that were associated with clinical progression and not to build a prognostic model, we tried to get an impression on how good these determinants in predicting clinical progression when they were present together. We also tested the discriminative ability of this model to get an indication on how good the presence of these determinants predicts the clinical progression of lower OA. Their cumulative presence provided a very good explanation of variation in clinical progression, as shown with R 2 of 48.6%. The AUCs of the ROC curves of 0.80 also indicates a reasonable discriminative ability. This means that performing assessment on these three determinants in clinical practice will help clinician much in predicting the progression of lower limb OA and therefore give better patient information. 70
18 Determinants of bad and good prognosis of lower limb OA Roos et al. showed that female sex was associated with worsening in self-reported pain and function and that older age and higher BMI were associated with worsening in function assessed on physical examination. On the other hand, we found no associations between demographic determinants and clinical progression. 5 Determinants for incidence are often failed to be identified as determinant of progression. The failure in finding determinants for progression is a common phenomenon that might be caused by methodological problem in studies restricted to subjects with existing disease. 24 Unfortunately, no method is yet available to overcome this problem. Another possible explanation in the difference in our results and results from Roos et al. is the difference in patient population. The population in the study of Roos was a mix of knee OA patients and participants who underwent menisectomy in the past. 3 Our study sample that consists of selected sib-pairs with OA at multiple sites has strengths and limitations. Since generalized OA (GOA) population is associated with rapid OA progression 25, our study population is suitable to investigate OA progression within a relatively short period. However, the generalizability of our results in other population settings, especially to general practice clinics is arguably limited and we could not investigate GOA as determinant for progression. Yet, if we compare the severity of OA by taking the incidence of joint prosthesis, we did not see much difference in the incidence of joint prosthesis in our study sample and in a hospital based OA population which was not selected for GOA, for a comparable follow-up time. 9 It supports the observations in other patient populations that generalized OA is also common and it is important to bear in mind that OA is often present at multiple sites while only the most symptomatic sites draw attention. 9,25 To leave out the familial effect, we have performed a correction for familial factors in analysis. The choice of the composite outcome that is a combination of two outcomes: joint prosthesis and increase in WOMAC pain or function scores above MPCI rewards comments. The two outcomes might be different; increase in WOMAC scores above MPCI might not always results in joint prosthesis. Also, the use of MPCI in defining progression is arbitrary. It was originally created to indicate clinical improvement in 71
19 trials. 8 However, since no clinical outcome regarding clinical progression of knee or hip or lower limb OA is available at this moment, our choice of outcome could be considered to be used in observational studies. It should be noted that our study population consists mainly of female. OA is known to be more common in female. The phenomenon that female tend to be overrepresented in OA studies is well known, such as in the large Bristol OA 500 study mentioned above. 9 In the present study, effort has been taken to adjust for this possible confounder. In summary, over a period of 6 years, more than half of the patients showed progression of lower limb OA, based on total joint replacement or change in selfreported pain or function above the MPCI. Performing combination of clinical and radiological assessment in clinical practice could evaluate the sub-group of patients with progression of lower limb OA. These findings would help doctors in patient information regarding progression of lower limb OA. Acknowledgements The authors would like to thank Dr. Naghmeh Riyazi and Dr. Stella Botha-Scheepers for performing clinical assessments. The author would also like to acknowledge support of the cooperating hospitals (Bronovo Hospital, The Hague: dr. ML Westedt; Jan van Breemen Instituut, Amsterdam: dr. D van Schaardenburg; Leyenburg Hospital, The Hague: dr. HK Ronday and dr. LN Coene; Reinier de Graaf Gasthuis, Delft: dr. AJ Peeters; Rijnland Hospital, Leiderdorp: dr. EJ van Langelaan) and referring rheumatologists, orthopedic surgeons, and general practitioners. 72
20 Determinants of bad and good prognosis of lower limb OA References (1) Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 1998 May;41(5): (2) Felson DT. Developments in the clinical understanding of osteoarthritis. Arthritis Res Ther 2009;11(1):203. (3) Cooper C, Snow S, McAlindon TE, Kellingray S, Stuart B, Coggon D, et al. Risk factors for the incidence and progression of radiographic knee osteoarthritis. Arthritis Rheum 2000 May;43(5): (4) Lane NE, Nevitt MC, Hochberg MC, Hung YY, Palermo L. Progression of radiographic hip osteoarthritis over eight years in a community sample of elderly white women. Arthritis Rheum 2004 May;50(5): (5) Roos EM, Bremander AB, Englund M, Lohmander LS. Change in selfreported outcomes and objective physical function over 7 years in middle-aged subjects with or at high risk of knee osteoarthritis. Ann Rheum Dis 2008 Apr;67(4): (6) O Reilly SC, Muir KR, Doherty M. Occupation and knee pain: a community study. Osteoarthritis Cartilage 2000 Mar;8(2): (7) Lacey RJ, Thomas E, Duncan RC, Peat G. Gender difference in symptomatic radiographic knee osteoarthritis in the Knee Clinical Assessment--CAS(K): a prospective study in the general population. BMC Musculoskelet Disord 2008;9:82. (8) Ehrich EW, Davies GM, Watson DJ, Bolognese JA, Seidenberg BC, Bellamy N. Minimal perceptible clinical improvement with the Western Ontario and McMaster Universities osteoarthritis index questionnaire and global assessments in patients with osteoarthritis. J Rheumatol 2000 Nov;27(11): (9) Dieppe P, Cushnaghan J, Tucker M, Browning S, Shepstone L. The Bristol OA500 study : progression and impact of the disease after 8 years. Osteoarthritis Cartilage 2000 Mar;8(2):63-8. (10) Belo JN, Berger MY, Reijman M, Koes BW, Bierma-Zeinstra SM. Prognostic factors of progression of osteoarthritis of the knee: a systematic review of observational studies. Arthritis Rheum 2007 Feb 15;57(1): (11) Wright AA, Cook C, Abbott JH. Variables associated with the progression of hip osteoarthritis: a systematic review. Arthritis Rheum 2009 Jul 15;61(7): (12) Riyazi N, Meulenbelt I, Kroon HM, Ronday KH, Hellio le Graverand MP, Rosendaal FR, et al. Evidence for familial aggregation of hand, hip, and spine but not knee osteoarthritis in siblings with multiple joint involvement: the GARP study. Ann Rheum Dis 2005 Mar;64(3): (13) Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 1986 Aug;29(8): (14) Altman R, Alarcon G, Appelrouth D, Bloch D, Borenstein D, Brandt K, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum 1991 May;34(5):
21 (15) Ware JE, Jr., Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992 Jun;30(6): (16) Aaronson NK, Muller M, Cohen PD, Essink-Bot ML, Fekkes M, Sanderman R, et al. Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol 1998 Nov;51(11): (17) Doyle DV, Dieppe PA, Scott J, Huskisson EC. An articular index for the assessment of osteoarthritis. Ann Rheum Dis 1981 Feb;40(1):75-8. (18) Altman RD, Gold GE. Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthritis Cartilage 2007;15 Suppl A:A1-56. (19) Zhang J, Yu KF. What s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA 1998 Nov 18;280(19): (20) Nilsdotter AK, Toksvig-Larsen S, Roos EM. Knee arthroplasty: are patients expectations fulfilled? A prospective study of pain and function in 102 patients with 5-year follow-up. Acta Orthop 2009 Feb;80(1): (21) Bykerk V. Anti-cyclic citrullinated peptide antibody versus HAQ/ MDHAQ: comparing apples and oranges? J Rheumatol 2009 Aug;36(8): (22) Bijsterbosch J, Wassenaar MJ, le CS, Slagboom PE, Rosendaal FR, Huizinga TW, et al. Doyle Index is a valuable additional pain measure in osteoarthritis. Osteoarthritis Cartilage 2010 May 14. (23) Zhang W, Doherty M, Peat G, Bierma- Zeinstra MA, Arden NK, Bresnihan B, et al. EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis. Ann Rheum Dis 2010 Mar;69(3): (24) Zhang Y, Niu J, Felson DT, Choi HK, Nevitt M, Neogi T. Methodologic challenges in studying risk factors for progression of knee osteoarthritis. Arthritis Care Res (Hoboken ) 2010 Nov;62(11): (25) Ledingham J, Regan M, Jones A, Doherty M. Factors affecting radiographic progression of knee osteoarthritis. Ann Rheum Dis 1995 Jan;54(1):
Cover Page. The handle holds various files of this Leiden University dissertation.
Cover Page The handle http://hdl.handle.net/1887/20431 holds various files of this Leiden University dissertation. Author: Yusuf, Erlangga Title: On how obesity links with osteoarthritis Issue Date: 2013-01-16
More informationunchanged; and the proportion with severe decreased from 7% to 4%; the proportion with mild pain decreased (48% to 32%;
Supplementary material to article by M. de Rooij et al. Course and predictors of pain and physical functioning in patients with hip osteoarthritis: Systematic review and meta-analysis and physical functioning
More informationCover Page. The handle holds various files of this Leiden University dissertation
Cover Page The handle http://hdl.handle.net/1887/28958 holds various files of this Leiden University dissertation Author: Keurentjes, Johan Christiaan Title: Predictors of clinical outcome in total hip
More informationInternational Cartilage Repair Society
OsteoArthritis and Cartilage (2006) 14, 1104e1110 ª 2006 OsteoArthritis Research Society International. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.joca.2006.04.011 Activity limitations
More informationCentral Reading of Knee X-rays for Kellgren & Lawrence Grade and Individual Radiographic Features of Tibiofemoral Knee OA
Central Reading of Knee X-rays for Kellgren & Lawrence Grade and Individual Radiographic Features of Tibiofemoral Knee OA 1. Overview... 1 1.1 SAS dataset... 1 1.2 Contents of dataset... 1 1.3 Merging
More informationValidity of joint space width measurements in hand osteoarthritis
Osteoarthritis and Cartilage 19 (2011) 1349e1355 Validity of joint space width measurements in hand osteoarthritis W.Y. Kwoky *, J. Bijsterboschy, S.H. Malmz, N.R. Biermaszz, K. Huetinkx, R.G. Nelissenk,
More informationARD Online First, published on August 3, 2005 as /ard
ARD Online First, published on August 3, 2005 as 10.1136/ard.2005.040642 Urinary CTX-II levels are associated with radiographic subtypes of osteoarthritis (OA) in hip, knee, hand and facet joints in subject
More informationCover Page. The handle holds various files of this Leiden University dissertation
Cover Page The handle http://hdl.handle.net/1887/28958 holds various files of this Leiden University dissertation Author: Keurentjes, Johan Christiaan Title: Predictors of clinical outcome in total hip
More informationPrevalence and development of hip and knee osteoarthritis according to American College of Rheumatology criteria in the CHECK cohort
Damen et al. Arthritis Research & Therapy (2019) 21:4 https://doi.org/10.1186/s13075-018-1785-7 RESEARCH Open Access Prevalence and development of hip and knee osteoarthritis according to American College
More informationAssessment of primary hip osteoarthritis: comparison of radiographic methods using colon radiographs
Assessment of primary hip osteoarthritis: comparison of radiographic methods using colon radiographs comparison of radiographic methods using colon radiographs Ingvarsson, T; Hägglund, Gunnar; Lindberg,
More informationVitamin D deficiency is associated with longer hospital stay and lower functional outcome after total knee arthroplasty.
Reference number to be mentioned by correspondence : ORTHO/- Acta Orthop. Belg., 2015, 83, 00-00 ORIGINAL STUDY Vitamin D deficiency is associated with longer hospital stay and lower functional outcome
More informationNon-commercial use only
Detection of progression of radiographic joint damage in case of very early osteoarthritis: sensitivity to change of quantitative analysis compared to qualitative grading Margot B. Kinds, 1,2 Anne C.A.
More informationH ip osteoarthritis (OA) affects 7 25% of white people
1028 EXTENDED REPORT Predictive factors of total hip replacement due to primary osteoarthritis: a prospective 2 year study of 505 patients L Gossec, F Tubach, G Baron, P Ravaud, I Logeart, M Dougados...
More informationT he WOMAC (Western Ontario and McMaster
8 EXTENDED REPORT Validation and patient acceptance of a computer touch screen version of the WOMAC 3.1 osteoarthritis index H A Bischoff-Ferrari, M Vondechend, N Bellamy, R Theiler... See end of article
More informationTitle: THE NATURAL HISTORY OF RADIOGRAPHIC KNEE OSTEOARTHRITIS: A FOURTEEN YEAR POPULATION-BASED COHORT STUDY
Full Length DOI 10.1002/art.34415 Title: THE NATURAL HISTORY OF RADIOGRAPHIC KNEE OSTEOARTHRITIS: A FOURTEEN YEAR POPULATION-BASED COHORT STUDY Running Head: Natural history of radiographic knee OA Authors:
More informationDiagnostic accuracy of range of motion measurements in early symptomatic hip and/or knee osteoarthritis
Chapter 1 Diagnostic accuracy of range of motion measurements in early symptomatic hip and/or knee osteoarthritis Jasmijn F.M. Holla, Marike van der Leeden, Leo D. Roorda, Sita M.A. Bierma-Zeinstra, Jurgen
More informationAssociations of radiological osteoarthritis of the hip and knee with locomotor disability in the Rotterdam Study
Ann Rheum Dis 1998;57:203 208 203 EXTENDED REPORTS Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, the Netherlands E Odding H A Valkenburg D Algra A Hofman R
More informationARTHROPATHY IN LONG-TERM CURED ACROMEGALY IS CHARACTERIZED BY OSTEOPHYTES WITHOUT JOINT-SPACE NARROWING: A COMPARISON WITH GENERALIZED OSTEOARTHRITIS.
Chapter 5. ARTHROPATHY IN LONG-TERM CURED ACROMEGALY IS CHARACTERIZED BY OSTEOPHYTES WITHOUT JOINT-SPACE NARROWING: A COMPARISON WITH GENERALIZED OSTEOARTHRITIS. M.J.E. Wassenaar 1, N.R. Biermasz 1, J.
More informationT he choice of an outcome measure is a major step in the
29 EXTENDED REPORT Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: the minimal clinically important improvement F Tubach, P Ravaud, G Baron, B Falissard,
More informationARD Online First, published on July 1, 2004 as /ard
ARD Online First, published on July 1, 2004 as 10.1136/ard.2003.019307 Validation and Patient Acceptance of a Computer Touch Screen Version of the WOMAC 3.1 Osteoarthritis Index Heike A Bischoff-Ferrari,
More informationDoes the SF-36 Mental Health Composite Score Predict Functional Outcome after Surgery in Patients with End Stage Ankle Arthritis?
Does the SF-36 Mental Health Composite Score Predict Functional Outcome after Surgery in Patients with End Stage Ankle Arthritis? Kennedy SA, Barske H, Penner M, Daniels T, Glazebrook M, Wing K, Dryden
More informationF. Birrell 1,3, M. Lunt 1, G. Macfarlane 2 and A. Silman 1
Rheumatology 2005;44:337 341 Advance Access publication 9 November 2004 Association between pain in the hip region and radiographic changes of osteoarthritis: results from a population-based study F. Birrell
More informationRadiographic assessment of symptomatic knee osteoarthritis in the community: definitions and normal joint space
Ann Rheum Dis 99;:9 9 Rheumatology Unit, City Hospital, Hucknall Road, Nottingham NG PB Correspondence to: Dr P Lanyon. Accepted for publication August 99 Radiographic assessment of symptomatic knee osteoarthritis
More informationRelevant change in radiological progression in patients with hip osteoarthritis. I. Determination using predictive validity for total hip arthroplasty
Rheumatology 2002;41:142 147 Relevant change in radiological progression in patients with hip osteoarthritis. I. Determination using predictive validity for total hip arthroplasty J. F. Maillefert 1,4,A.Gueguen
More informationRadiographic Osteoarthritis and Serum Triglycerides
Bahrain Medical Bulletin, Vol. 25, No. 2, June 2003 Radiographic Osteoarthritis and Serum Triglycerides Abdurhman S Al-Arfaj, FRCPC, MRCP(UK), FACP, FACR* Objectives: In view of the many studies linking
More informationParticipation in Adults Post Total Knee Replacement
Participation in Adults Post Total Knee Replacement Jessica Maxwell, PT, DPT, OCS Boston University College of Health and Rehabilitation Sciences: Sargent College Boston University Medical Center Learning
More informationCristal Castellanos 1, Abelardo Camacho 2, Klaus Mieth 3, Gamal Zayed 3, German Carrillo 3, Oscar Rivero 4, Rafael Gómez 4, Sara Jaimes 4
Inter- And Intra-Observer Concordance Of The Modified Kellgren And Lawrence Scale For Knee Osteoarthritis By Compartments In Patients Of The University Hospital Fundación Santa Fe De Bogotá, Colombia.
More informationInternational Cartilage Repair Society
Osteoarthritis and Cartilage (2002) 10, 849 854 2002 OsteoArthritis Research Society International. Published by Elsevier Science Ltd. All rights reserved. 1063 4584/02/$35.00/0 doi:10.1053/joca.2002.0840,
More informationDISCLOSURES. T. McAlindon: Samumed, grant/research support; Astellas, Flexion, Pfizer, Regeneron, Samumed,and Seikugaku, consulting
Radiographic Outcomes from a Randomized, Double- Blind, Placebo-Controlled, Phase 2 Study of a Novel, Intra-Articular, Wnt Pathway Inhibitor (SM04690) for the Treatment of Osteoarthritis of the Knee: Week
More informationClinical Study Relationships between Pain, Function and Radiographic Findings in Osteoarthritis of the Knee: A Cross-Sectional Study
Arthritis Volume 2012, Article ID 984060, 5 pages doi:10.1155/2012/984060 Clinical Study Relationships between Pain, Function and Radiographic Findings in Osteoarthritis of the Knee: A Cross-Sectional
More informationOsteoarthritis and Cartilage (1995) 3, Osteoarthritis Research Society /95/ $08.00/0
Osteoarthritis and Cartilage (1995) 3, 205-209 1995 Osteoarthritis Research Society 1063-4584/95/030205 + 05 $08.00/0 OSTEOARTHRITIS and CARTILAGE Increased rate of hysterectomy in women undergoing surgery
More informationInternational Cartilage Repair Society
OsteoArthritis and Cartilage (2006) 14, 496e500 ª 2005 OsteoArthritis Research Society International. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.joca.2005.12.001 Short communication
More informationValidity and Reliability of Radiographic Knee Osteoarthritis Measures by Arthroplasty Surgeons
Validity and Reliability of Radiographic Knee Osteoarthritis Measures by Arthroplasty Surgeons Daniel L. Riddle, PhD; William A. Jiranek, MD; Jason R. Hull, MD abstract Full article available online at
More informationCover Page. The handle holds various files of this Leiden University dissertation.
Cover Page The handle http://hdl.handle.net/1887/30244 holds various files of this Leiden University dissertation. Author: Claessen, Kim Maria Johanna Aldegonda Title: Pathophysiology of the GH/IGF-1 axis
More informationPrevention of knee osteoarthritis in overweight females; the first preventive randomized
*Manuscript Click here to view linked References 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Prevention of knee osteoarthritis in overweight females; the first preventive randomized controlled
More informationIn the Treatment of Patients With Knee Joint Osteoarthritis, Are Platelet Rich Plasma Injections More Effective Than Hyaluronic Acid Injections?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2015 In the Treatment of Patients With Knee
More informationO steoarthritis (OA) of the hip is of particular interest as
1427 EXTENDED REPORT Validity and reliability of three definitions of hip osteoarthritis: cross sectional and longitudinal approach M Reijman, J M W Hazes, H A P Pols, R M D Bernsen, B W Koes, S M A Bierma-Zeinstra...
More informationREXON-AGE therapy in the treatment of arthrosis
Presidio Ospedaliero di Cittadella Unità Operativa Autonoma ANESTESIA RIANIMAZIONE E TERAPIA DEL DOLORE Direttore: Dott. Giandomenico BABBOLIN Via Riva Ospedale 35013 Cittadella / Padova Tel. 049.942.48.01/3
More informationOsteoarthritis (OA), the most common joint
Effect of Rofecoxib Therapy on Measures of Health-Related Quality of Life in Patients With Osteoarthritis Elliot W. Ehrich, MD; James A. Bolognese, MStat; Douglas J. Watson, PhD; and Sheldon X. Kong, PhD
More informationChristopher J. Swearingen, Sarah Kennedy, Jeyanesh R.S. Tambiah. Samumed LLC, San Diego, CA, USA
Radiographic Outcomes Were Concordant with Pain and Function Response: Post-Hoc Analysis from a Phase 2 Study of SM04690, a Wnt Pathway Inhibitor for Knee Osteoarthritis Treatment Christopher J. Swearingen,
More informationTable of Contents. Overview Introduction Variables Missing Data Image Type Time Points Reading Methods...
MULTICENTER OSTEOARTHRITIS STUDY LONGITUDINAL KNEE RADIOGRAPH ASSESSMENTS (BASELINE TO 15-MONTH, 30-MONTH, 60-MONTH AND 84-MONTH FOLLOW-UP) AND MEASUREMENTS FROM BASELINE FULL LIMB RADIOGRAPHS DATASET
More informationCover Page. The handle holds various files of this Leiden University dissertation.
Cover Page The handle http://hdl.handle.net/188/20915 holds various files of this Leiden University dissertation. Author: Flinterman, Linda Elisabeth Title: Risk factors for a first and recurrent venous
More informationTitle:Prediction of poor outcomes six months following total knee arthroplasty in patients awaiting surgery
Author's response to reviews Title:Prediction of poor outcomes six months following total knee arthroplasty in patients awaiting surgery Authors: Eugen Lungu (eugen.lungu@umontreal.ca) François Desmeules
More informationOsteoarthritis as a public health problem: the impact of developing knee pain on physical function in adults living in the community: (KNEST 3)
Rheumatology 2007;46:877 881 Advance Access publication 17 February 2007 doi:10.1093/rheumatology/kem013 Osteoarthritis as a public health problem: the impact of developing knee pain on physical function
More informationT he goals of medical management of patients with
1061 EXTENDED REPORT Development of radiographic changes of osteoarthritis in the Chingford knee reflects progression of disease or non-standardised positioning of the joint rather than incident disease
More informationQuality measures in osteoarthritis
Quality measures in osteoarthritis M.C. Hochberg Marc C. Hochberg, MD, MPH, Professor of Medicine and Epidemiology and Preventive Medicine, Head, Division of Rheumatology and Clinical Immunology, University
More informationPerformance of the Ankylosing Spondylitis Disease Activity Score (ASDAS) in patients under biological therapies
Performance of the Ankylosing Spondylitis Disease Activity Score (ASDAS) in patients under biological therapies 1. Introduction The Ankylosing Spondylitis Disease Activity Score (ASDAS) is a new instrument
More informationCoronal Tibiofemoral Subluxation in Knee Osteoarthritis
Coronal Tibiofemoral Subluxation in Knee Osteoarthritis Saker Khamaisy, MD 1,2 * ; Hendrik A. Zuiderbaan, MD 1 ; Meir Liebergall, MD 2; Andrew D. Pearle, MD 1 1Hospital for Special Surgery, Weill Medical
More informationHormone replacement therapy and patterns of osteoarthritis: baseline data from the Ulm Osteoarthritis Study
Ann Rheum Dis 2000;59:105 109 105 Department of Epidemiology, University of Ulm, Germany, Helmholtzstr 22, D-89081 Ulm, Germany A Erb H Brenner T Stürmer Department of Orthopaedic Surgery, University of
More informationFactors Affecting Radiographic Progression of Knee Osteoarthritis
IGINAL ARTICLE Factors Affecting Radiographic Progression of Knee Osteoarthritis Harry Isbagio ABSTRACT Aim: to determine factors affecting radiographic progression of knee OA. Methods: a cross sectional
More informationMedical Policy Original Effective Date: Revised Date: 07/26/17 Page 1 of 9
Page 1 of 9 Disclaimer Description Coverage Determination/ Clinical Indications Refer to the member s specific benefit plan and Schedule of Benefits to determine coverage. This may not be a benefit on
More informationInternet Journal of Medical Update
Internet Journal of Medical Update 2012 January;7(1):47-51 Internet Journal of Medical Update Journal home page: http://www.akspublication.com/ijmu Original Work CIFKAS A Measurer of Functional Disability
More informationImmediate Effects of Simple Quadriceps Exercises in Osteoarthritis Knee Pain among Overweight Individuals
Immediate Effects of Simple Quadriceps Exercises in Osteoarthritis Knee Pain among Overweight Individuals M. Karthikeyan, R.Lavanya Ashitha 2, Prof. V. P. R Sivakumar 3 Assistant Professor, SRM College
More informationA Comparative Study of Ultrasonographic Findings with Clinical and Radiological Findings of Painful Osteoarthritis of the Knee Joint
Med. J. Cairo Univ., Vol. 84, No. 3, December: 97-, www.medicaljournalofcairouniversity.net A Comparative Study of Ultrasonographic Findings with Clinical and Radiological Findings of Painful Osteoarthritis
More informationDistribution of Finger Nodes and Their Association With Underlying Radiographic Features of Osteoarthritis
Arthritis Care & Research Vol. 64, No. 4, April 2012, pp 533 538 DOI 10.1002/acr.21586 2012, American College of Rheumatology ORIGINAL ARTICLE Distribution of Finger Nodes and Their Association With Underlying
More informationInternational Cartilage Repair Society
Osteoarthritis and Cartilage (2009) 17, 427e432 ª 2008 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.joca.2008.05.022 Effect of glucosamine
More informationThe prevalence and history of knee osteoarthritis in general practice: a case control study
The Author (2005). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org doi:10.1093/fampra/cmh700 Family Practice Advance Access
More informationARTICLE IN PRESS. All-Patient Refined Diagnosis- Related Groups in Primary Arthroplasty
The Journal of Arthroplasty Vol. 00 No. 0 2009 All-Patient Refined Diagnosis- Related Groups in Primary Arthroplasty Carlos J. Lavernia, MD,*y Artit Laoruengthana, MD,y Juan S. Contreras, MD,y and Mark
More informationO steoarthritis (OA) is the most common joint disorder1
226 REVIEW Validity, reliability, and applicability of seven definitions of hip osteoarthritis used in epidemiological studies: a systematic appraisal M Reijman, J M W Hazes, B W Koes, A P Verhagen, S
More informationTo study the efficacy of Rhus tox in management of cases of osteoarthritis of knee joint
International Journal of Research in Orthopaedics Rajgurav AB et al. Int J Res Orthop. 2017 Jan;3(1):54-60 http://www.ijoro.org Original Research Article DOI: http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20164832
More informationTemplate 1 for summarising studies addressing prognostic questions
Template 1 for summarising studies addressing prognostic questions Instructions to fill the table: When no element can be added under one or more heading, include the mention: O Not applicable when an
More informationOsteoarthritis (OA) is a major cause of pain
Menopause: The Journal of The North American Menopause Society Vol. 11, No. 2, pp. 138 143 DOI: 10.1097/01.GME.0000087983.28957.5D 2004 The North American Menopause Society Text printed on acid-free paper.
More informationCAN WE PREDICT SURGERY FOR SCIATICA?
7 CAN WE PREDICT SURGERY FOR SCIATICA? Improving prediction of inevitable surgery during non-surgical treatment of sciatica. Wilco C. Peul Ronald Brand Raph T.W.M. Thomeer Bart W. Koes Submitted for publication
More informationProject 15 Test-Retest Reliability of Semi-quantitative Readings from Knee Radiographs
Project 15 Test-Retest Reliability of Semi-quantitative Readings from Knee Radiographs 1. SAS dataset... 1 2. Purpose and methods... 1 2.1 Background... 1 2.2 Reliability at single time points... 1 2.3
More informationThe Prevalence of Knee Osteoarthritis in Elderly Community Residents in Korea
J Korean Med Sci 2010; 25: 293-8 ISSN 1011-8934 DOI: 10.3346/jkms.2010.25.2.293 The Prevalence of Knee Osteoarthritis in Elderly Community Residents in Korea The purpose of this study was to estimate the
More informationOsteoarthritis and Cartilage (1998) 6, Osteoarthritis Research Society /98/ $12.00/0
Osteoarthritis and Cartilage (1998) 6, 79 86 1998 Osteoarthritis Research Society 1063 4584/98/020079 + 08 $12.00/0 Comparison of the WOMAC (Western Ontario and McMaster Universities) osteoarthritis index
More informationHand osteoarthritis and pinch grip strength among middle-aged female dentists and teachers
84 Scand J Rheumatol 2010;39:8487 Hand osteoarthritis and pinch grip strength among middle-aged female dentists and teachers H Ding, S Solovieva, T Vehmas, E-P Takala, P Leino-Arjas Finnish Institute of
More informationT otal hip replacement (THR) is one of the most successful
923 EXTENDED REPORT Predictors of patient relevant outcome after total hip replacement for osteoarthritis: a prospective study A-K Nilsdotter, I F Petersson, E M Roos, L S Lohmander... See end of article
More informationInternational Journal of Orthopaedics Sciences 2017; 3(1): Dr. Sunil Kumar TR and Dr. Harish YS
2017; 3(1): 658-663 ISSN: 2395-1958 IJOS 2017; 3(1): 658-663 2017 IJOS www.orthopaper.com Received: 07-11-2016 Accepted: 08-12-2016 Dr. Sunil Kumar TR Senior Resident, ESIC Medical College and Model Hospital
More informationARD Online First, published on October 11, 2005 as /ard
ARD Online First, published on October 11, 2005 as 10.1136/ard.2005.038414 The relationship of Progressive Osteoarthritis of the Knee and Long-term Progression of Osteoarthritis of the Hand, Hip and Lumbar
More informationAssociation of Squatting With Increased Prevalence of Radiographic Tibiofemoral Knee Osteoarthritis
ARTHRITIS & RHEUMATISM Vol. 50, No. 4, April 2004, pp 1187 1192 DOI 10.1002/art.20127 2004, American College of Rheumatology Association of Squatting With Increased Prevalence of Radiographic Tibiofemoral
More informationCollected Scientific Research Relating to the Use of Osteopathy with Knee pain including iliotibial band (ITB) friction syndrome
Collected Scientific Research Relating to the Use of Osteopathy with Knee pain including iliotibial band (ITB) friction syndrome Important: 1) Osteopathy involves helping people's own self-healing abilities
More informationExpert Consensus Implication of Unloader braces in guideline recommended knee OA management Who, when and how?
Expert Consensus Implication of Unloader braces in guideline recommended knee OA management Who, when and how? Christian Inngul MD, PhD Consultant orthopeadic surgeon, Stockholm South General Hospital
More information11/5/2011. Disclosure. Evidence Based Medicine (EBM) ADAPT Clinical Outcomes. 18-month Clinical Outcomes
11/5/2011 and for Arthritis (IDEA) : 18-month Clinical Outcomes Disclosure Messier, S.P., Nicklas, B., Legault, C., Mihalko, S., Miller, G.D., DeVita, P., Hunter, D.J., Eckstein, F., Williamson, J.D.,
More informationInternational Cartilage Repair Society
OsteoArthritis and Cartilage (26) 14, A14eA18 ª 26 OsteoArthritis Research Society International. Published by Elsevier Ltd. All rights reserved. doi:116/j.joca.26.2.22 Assessment of joint space narrowing
More informationFactors for Pain in Patients With Different Grades of Knee Osteoarthritis
Arthritis Care & Research Vol. 65, No. 5, May 2013, pp 695 702 DOI 10.1002/acr.21886 2013, American College of Rheumatology ORIGINAL ARTICLE Factors for ain in atients With Different Grades of Knee Osteoarthritis
More informationThe factors which affect the cartilage thickness of ankle joint
The factors which affect the cartilage thickness of ankle joint Fei Chang, YunLong Jia, Yao Fu, HanYang Zhang, Zhuan Zhong,QuanYu Dong The Second Hospital of Jilin University, Changchun, China Declaration
More informationFunctional Outcome of Uni-Knee Arthroplasty in Asians with six-year Follow-up
Functional Outcome of Uni-Knee Arthroplasty in Asians with six-year Follow-up Ching-Jen Wang, M.D. Department of Orthopedic Surgery Kaohsiung Chang Gung Memorial Hospital Chang Gung University College
More informationcontinued TABLE E-1 Outlines of the HRQOL Scoring Systems
Page 1 of 10 TABLE E-1 Outlines of the HRQOL Scoring Systems System WOMAC 18 KSS 21 OKS 19 KSCR 22 AKSS 22 ISK 23 VAS 20 KOOS 24 SF-36 25,26, SF-12 27 Components 24 items measuring three subscales. Higher
More informationSasaki E 1,2, Otsuka H 2, Sasaki N 2, and Ishibashi Y 1
Influence of osteophyte resection of the posterior femoral condyle on extension range of motion and gap balance in cruciate retaining type total knee arthroplasty. - Intraoperative evaluation using navigation
More informationInternational Cartilage Repair Society
Osteoarthritis and Cartilage (2007) 15, 454e461 ª 2006 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.joca.2006.10.008 Three-month efficacy
More informationNon-Surgical vs. Surgical Treatment of Meniscus Tears of the Knee
Non-Surgical vs. Surgical Treatment of Meniscus Tears of the Knee Greg I. Nakamoto, MD FACP Section of Orthopedics and Sports Medicine Virginia Mason Medical Center CASE 1 45 y/o construction worker sent
More informationwhy bicompartmental? A REVOLUTIONARY ALTERNATIVE TO TOTAL KNEE REPLACEMENTS
why bicompartmental? A REVOLUTIONARY ALTERNATIVE TO TOTAL KNEE REPLACEMENTS TKR is not always the answer Today, many patients with medial or lateral disease and patellofemoral involvement receive a Total
More informationOsteoarthritis. Dr Anthony Feher. With special thanks to Dr. Tim Williams and Dr. Bhatia for allowing me to use some of their slides
Osteoarthritis Dr Anthony Feher With special thanks to Dr. Tim Williams and Dr. Bhatia for allowing me to use some of their slides No Financial Disclosures Number one chronic disability in the United States
More informationIntroduction. Ainna Binti Mohamad Dat, 1 Tertianto Prabowo, 2 Alwin Tahid 3. Abstract
453 Body Mass Index and Western Ontario & McMaster Universities Osteoarthritis Index in Patients with Knee Osteoarthritis in Dr. Hasan Sadikin General Hospital, Bandung in November 2012 Ainna Binti Mohamad
More informationCLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION
Donald L. Renfrew, MD Radiology Associates of the Fox Valley, 333 N. Commercial Street, Suite 100, Neenah, WI 54956 7/28/2012 Radiology Quiz of the Week # 83 Page 1 CLINICAL PRESENTATION AND RADIOLOGY
More informationMeasurement of Radiographic Joint Space Width in the Tibiofemoral Compartment of the Osteoarthritic Knee
ARTHRITIS & RHEUMATISM Vol. 48, No. 2, February 2003, pp 378 384 DOI 10.1002/art.10773 2003, American College of Rheumatology Measurement of Radiographic Joint Space Width in the Tibiofemoral Compartment
More informationWAIT TIMES TO RHEUMATOLOGY AND REHABILITATION SERVICES: IS RHEUMATOID ARTHRITIS PRIORITIZED?
WAIT TIMES TO RHEUMATOLOGY AND REHABILITATION SERVICES: IS RHEUMATOID ARTHRITIS PRIORITIZED? Ashley Delaurier PT M.Sc. Candidate Biomedical Sciences University of Montreal ashley.delaurier@umontreal.ca
More informationBetter Outcomes for Older People with Spinal Trouble (BOOST) Research Programme
Better Outcomes for Older People with Spinal Trouble (BOOST) Research Programme Background Low back pain (LBP) is now recognised as the leading disabling condition in the world. LBP is a highly variable
More informationIndian Journal of Basic and Applied Medical Research; December 2013: Vol.-3, Issue-1, P
Original article: Effectiveness between supervised clinical exercise with Maitland manual therapy and Home exercise program in treating osteoarthritis of knee: Comparative study 1Dr.Mrs. Swati Sandeep
More informationSHAWN FARROKHI, SARA R. PIVA, ALEXANDRA B. GIL, CHESTER V. ODDIS, MARIA M. BROOKS,
Arthritis Care & Research Vol. 65, No. 4, April 2013, pp 544 551 DOI 10.1002/acr.21866 2013, American College of Rheumatology ORIGINAL ARTICLE Association of Severity of Coexisting Patellofemoral Disease
More informationIntroduction ARTICLE INFO. Key Words: osteoarthritis, knee, function, pain AUTHORS AFFILIATIONS 1
International Journal of Therapies and Rehabilitation Research [E-ISSN: 2278-343] http://www.scopemed.org/?jid=12 IJTRR 15, 4: 4 I doi:.5455/ijtrr.76 Original Article Open Access Correlation of fear avoidance
More informationPhysical activity, alignment and knee osteoarthritis: data from MOST and the OAI
Osteoarthritis and Cartilage 21 (2013) 789e795 Physical activity, alignment and knee osteoarthritis: data from MOST and the OAI D.T. Felson yzz *, J. Niu y, T. Yang y, J. Torner #, C.E. Lewis k, P. Aliabadi
More informationDOI /acr.22674
Original Article DOI 10.1002/acr.22674 The longitudinal course of physical function in people with symptomatic knee osteoarthritis: Data from the MOST study and the OAI Britt Elin Øiestad, PT, PhD 1, Daniel
More informationIJDDT. Effects of Quadriceps Dynamic Strengthening and Isometrics Exercise in Non-obese and Obese Osteoarthritis of Knee Joint Patients
IJDDT International Journal of Drug Discovery and Technology IJDDT 2(1) (2011): 47-53 Research Science Press Effects of Quadriceps Dynamic Strengthening and Isometrics Exercise in Non-obese and Obese Osteoarthritis
More information6/30/2015. Quadriceps Strength is Associated with Self-Reported Function in Arthroscopic Partial Meniscectomy Patients. Surgical Management
Quadriceps Strength is Associated with Self-Reported Function in Arthroscopic Partial Meniscectomy Patients Meniscal tears no cause for concern? Among the most common injuries of the knee in sport and
More informationSCALENE ASIA PACIFIC SDN BHD ROTATIONAL FIELD QUANTUM NUCLEAR MAGNETIC RESONANCE (RFQMR) IN TREATMENT OF OSTEOARTHRITIS OF THE KNEE JOINT
SCALENE ASIA PACIFIC SDN BHD ROTATIONAL FIELD QUANTUM NUCLEAR MAGNETIC RESONANCE (RFQMR) IN TREATMENT OF OSTEOARTHRITIS OF THE KNEE JOINT ROTATIONAL FIELD QUANTUM NUCLEAR MAGNETIC RESONANCE (RFQMR) IN
More informationThe Impact of Centralized Pain on Acute and Chronic Post-surgical Pain
The Impact of Centralized Pain on Acute and Chronic Post-surgical Pain Chad M. Brummett, M.D. Associate Professor Director, Clinical Anesthesia Research Director, Pain Research Department of Anesthesiology
More informationHealth-Related Quality of Life and Functional Outcomes in Ankle Arthritis Patients Based on Treating with and without Total Ankle Replacement Surgery
Health-Related Quality of Life and Functional Outcomes in Ankle Arthritis Patients Based on Treating with and without Total Ankle Replacement Surgery Chayanin Angthong MD* * Division of Foot and Ankle
More information